Marine Cargo Insurance Application Form
1. Applicant Information
Full Name / Company
Address
Contact Person
Phone Number
Email
2. Cargo Details
Description of Cargo
Packing Type
Quantity
Total Weight (kg)
Total Cargo Value (in currency)
3. Voyage / Transit Details
Place of Origin
Final Destination
Vessel Name
Voyage Number
Date of Departure
Expected Arrival Date
Mode of Transit
Sea
Air
Road
Rail
Multimodal
Containerized?
Yes
No
4. Insurance Details
Type of Cover Required
All Risk
Total Loss Only
Other
Period of Insurance
Additional Information
5. Declaration
I/We declare that information given is true and complete.
Signature
Date